Branch stent graft and delivery method for endovascular treatment of the iliac artery aneurysms

ABSTRACT

An iliac branch device has an external iliac body, a common iliac branch, and an internal iliac branch. A diameter of the proximal opening of the common iliac branch is greater than a diameter of a distal opening of the external iliac body. The iliac branch device is configured to be deployed without going up and over the aortic bifurcation and without using some form of supra-aortic antegrade access such as through brachial or axillary artery access. This simplifies the procedure and reduces procedure time thus maximizing the success rate of the procedure and allows the procedure to be performed on a broad patient population.

FIELD

The present technology is generally related to an intra-vascular deviceand method. More particularly, the present application relates to adevice for treatment of intra-vascular diseases.

BACKGROUND

Iliac artery aneurysms in close proximity to the iliac bifurcationpresent an unmet clinical need for vascular surgeons versed inendovascular repair. One treatment option includes open surgery, whichis highly invasive with associated long recovery and hospital staytimes.

Another treatment option includes sacrificing the internal iliac arteryby covering the internal iliac artery with a stent graft. Unfortunately,covering the internal iliac artery leads to poor quality of life fromcomplications related to groin ischemia.

Yet another treatment option involves sealing a stent graft in thediseased (aneurysmal) common iliac artery. However, this option isassociated with high rates of degeneration leading to futurecomplications and reinterventions.

Challenges in the above options often lead the vascular surgeon to usedlimited commercially available iliac branch stent graft systems. Theavailable iliac branch stent graft systems require high skill level,multiple accessory devices, and multiple surgical access points.

SUMMARY

The techniques of this disclosure generally relate to an iliac branchdevice having an external iliac body, a common iliac branch, and aninternal iliac branch. A diameter of the proximal opening of the commoniliac branch is greater than a diameter of a distal opening of theexternal iliac body. The iliac branch device is configured to bedeployed without going up and over the aortic bifurcation and withoutusing some form of supra-aortic antegrade access such as throughbrachial or axillary artery access. This simplifies the procedure andreduces procedure time thus maximizing the success rate of the procedureand allows the procedure to be performed on a broad patient population.

In one aspect, the present disclosure provides an assembly comprising aninner member and an iliac branch device having the inner member therein.The iliac branch device includes an external iliac body configured to belocated within an external iliac artery, a common iliac branchconfigured to be located with a common iliac artery, and an internaliliac branch configured to perfuse an internal iliac artery.

In another aspect, the present disclosure provides a method comprisingloading an iliac branch device within a delivery system having a handle.The iliac branch device includes an external iliac body, a common iliacbranch, and an internal iliac branch. The external iliac body isproximal to both the common iliac branch and the internal iliac branchrelative to the handle.

The details of one or more aspects of the disclosure are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of the techniques described in this disclosurewill be apparent from the description and drawings, and from the claims.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a perspective view of an iliac branch device in accordancewith one embodiment.

FIG. 2 is a perspective view of an iliac branch device in accordancewith another embodiment.

FIG. 3 is a perspective view of a delivery system including the iliacbranch device of FIG. 1 in accordance with one embodiment.

FIG. 4 is a partial cross-sectional view of a vessel assembly includingthe iliac branch device of FIG. 1 in accordance with one embodiment.

FIG. 5 is an enlarged view of the region V of the vessel assembly ofFIG. 4 in accordance with one embodiment.

FIG. 6 is a partial cross-sectional view of the vessel assembly of FIG.5 at a later stage during deployment of a bridging graft in accordancewith one embodiment.

FIG. 7 is an enlarged view of the region V of the vessel assembly ofFIG. 4 after deployment of the iliac branch device of FIG. 2 inaccordance with one embodiment.

FIG. 8 is a partial cross-sectional view of the vessel assembly of FIG.7 at a later stage during deployment of a bridging graft in accordancewith one embodiment.

FIG. 9 is a partial cross-sectional view of the vessel assembly of FIG.6 at a later stage after deployment of an aortic bifurcated stent graftin accordance with one embodiment.

FIG. 10A is an enlarged view of the region X of the vessel assembly ofFIG. 9 in accordance with one embodiment.

FIG. 10B is an enlarged view of the region X of the vessel assembly ofFIG. 9 in accordance with another embodiment.

FIG. 11 is a partial cross-sectional view of the vessel assembly of FIG.6 at a later stage after deployment of an aortic bifurcated stent graftin accordance with another embodiment.

FIG. 12 is an enlarged view of the region V of the vessel assembly ofFIG. 4 in accordance with one embodiment.

DETAILED DESCRIPTION

FIG. 1 is a perspective view of an iliac branch device 100 in accordancewith one embodiment. Iliac branch device 100 includes an external iliacbody 102, internal iliac branch 104, and a common iliac branch 106.External iliac body 102, internal iliac branch 104, and common iliacbranch 106 are sometimes called an external iliac body 102, a firstbifurcated leg 104, and a second bifurcated leg 106, respectively.

In accordance with this embodiment, external iliac body 102 includesdistal opening 108 at a distal end 110 of external iliac body 102. Aproximal end 112 of external iliac body 102 is coupled to a proximal end114 of internal iliac branch 104 and a distal end 116 of common iliacbranch 106.

Internal iliac branch 104 includes an internal iliac distal opening 118at a distal end 120 of internal iliac branch 104. Common iliac branch106 includes a common iliac proximal opening 122 at a proximal end 124of common iliac branch 106.

As used herein, the proximal end of a prosthesis such as iliac branchdevice 100 is the end closest to the heart via the path of blood flowwhereas the distal end is the end furthest away from the heart duringdeployment. As discussed below, blood flow enters into proximal opening122 of common iliac branch 106 and exits distal openings 108, 118 ofexternal iliac body 102 and internal iliac branch 104 respectively.Generally, there is retrograde blood flow through internal iliac branch104. Accordingly, proximal end 112 of external iliac body 102 is coupledto proximal end 114 of internal iliac branch 104 and distal end 116 ofcommon iliac branch 106 at a transition region 126.

In contrast and of note, the distal end of the delivery system isusually identified to the end that is farthest from the operator/handlewhile the proximal end of the delivery system is the end nearest theoperator/handle. For purposes of clarity of discussion, as used herein,the distal end of the delivery system is the end that is farthest fromthe operator (the end furthest from the handle). However, those of skillin the art will understand that depending upon the access location,iliac branch device 100 and/or the delivery system descriptions may bedifferent in actual usage.

Iliac branch device 100 includes graft material 128 and one or morecircumferential stents 130 coupled to graft material 128. Graft material128 may be any suitable graft material, for example and not limited to,woven polyester, DACRON® material, expanded polytetrafluoroethylene,polyurethane, silicone, electro spun materials, or other suitablematerials.

Circumferential stents 130 may be coupled to graft material 128 usingstitching or other means. In the embodiment shown in FIG. 1,circumferential stents 130 are coupled to an outside surface of graftmaterial 128. However, circumferential stents 130 may alternatively becoupled to an inside surface of graft material 128.

Although shown with a particular number of circumferential stents 130,in light of this disclosure, those of skill in the art will understandthat iliac branch device 100 may include a greater or smaller number ofstents 130, e.g., depending upon the desired length of external iliacbody 102, internal iliac branch 104, and common iliac branch 106 and/orthe intended application thereof.

Circumferential stents 130 may be any stent material or configuration.As shown, circumferential stents 130, e.g., self-expanding members, arepreferably made from a shape memory material, such as nickel-titaniumalloy (nitinol), and are formed into a zig-zag configuration. Theconfiguration of circumferential stents 130 is merely exemplary, andcircumferential stents 130 may have any suitable configuration,including but not limiting to a continuous or non-continuous helicalconfiguration. In another embodiment, circumferential stents 130 areballoon expandable stents. In one embodiment, bare stents and/ordelivery system interfaces which increase control over delivery areincluded. Further, in one embodiment, there are radiopaque markers thatassist in orientating iliac branch device 100.

A lumen 132 is defined by external iliac body 102. Lumen 132 extendsbetween distal opening 108 and proximal end 112 of external iliac body102. External iliac body 102 increases in diameter from distal opening108 to proximal end 112. However, in other embodiments, external iliacbody 102 is uniform in diameter or decreases in diameter from distalopening 108 to proximal end 112.

Further, a lumen 134 is defined by internal iliac branch 104. Lumen 134extends between proximal end 114 and distal opening 118 of internaliliac branch 104. Internal iliac branch 104 is cylindrical having asubstantially uniform diameter in this embodiment. However, in otherembodiments, internal iliac branch 104 varies in diameter.

Further, a lumen 136 is defined by common iliac branch 106. Lumen 136extends between proximal opening 122 and distal end 116 of common iliacbranch 106. Common iliac branch 106 decreases in diameter from proximalopening 122 to distal end 116. However, in other embodiments, commoniliac branch 106 is uniform in diameter or increases in diameter fromproximal opening 122 to distal end 116.

Generally, external iliac body 102 is bifurcated at proximal end 112(transition region 126) into internal iliac branch 104 and common iliacbranch 106. More particularly, lumen 132 of external iliac body 102 isbifurcated into lumen 134 of internal iliac branch 104 and lumen 136 ofcommon iliac branch 106.

In accordance with this embodiment, openings 108, 118, and 122 ofexternal iliac body 102, internal iliac branch 104, and common iliacbranch 106 have diameters D1, D2, and D3, respectively, in their relaxedand expanded configuration. Illustratively, diameter D3 is in the rangeof 12 to 28 millimeters (mm), diameter D2 is less than 12 mm, anddiameter D1 is in the range of 8 to 14 mm.

In one embodiment, diameter D3 of opening 122 of common iliac branch 106is greater than either of diameters D1 and D2 of opening 108 of externaliliac body 102 and opening 118 of internal iliac branch 104,respectively. However, in other embodiments, diameter D1 is greater thanor equal to diameter D3, e.g., diameter D3 is 12 mm and diameter D1 isup to 14 mm.

FIG. 2 is a perspective view of an iliac branch device 100A inaccordance with another embodiment. Iliac branch device 100A of FIG. 2is similar to iliac branch device 100 of FIG. 1 and only the significantdifferences are discussed below. More particularly, iliac branch device100A includes external iliac body 102 and common iliac branch 106 whichare similar or identical to external iliac body 102 and common iliacbranch 106 of iliac branch device 100 and so are not discussed further.

Referring now to FIG. 2, an internal iliac branch 104A is curved,sometimes called having a hook shape, a “J” shape, or a “candy cane”shape. More particular, internal iliac branch 104A curves away fromcommon iliac branch 106 such that distal opening 118 points away fromcommon iliac branch 106. The curved shape of internal iliac branch 104Afacilitates cannulation of the internal iliac artery as discussedfurther below.

In one embodiment, internal iliac branch 104A includes a curving member238 that curves internal iliac branch 104A. Curving member 238 includesa curved wire, stitching, or other feature that curves internal iliacbranch 104A in various embodiments. A pre-shaped, curved wire could beconstructed from a superelastic or traditional alloy and be attached tothe inner curve of the flexible internal iliac branch 104A to forcecurvature. The attachment could be to the inside or outside of internaliliac branch 104A by way of suture material. Alternatively, a seamedchannel could be created in the graft material of internal iliac branch104A with the wire floating freely inside. A second (or multiple)wires(s) could further act to form this shape. Alternatively, astitching pattern could establish a morphology of the graft material ofinternal iliac branch 104A that when pressurized would assume the hookshape, thus eliminating the need for a wire member.

FIG. 3 is a perspective view of a delivery system 300 including iliacbranch device 100 of FIG. 1 in accordance with one embodiment. Deliverysystem 300 includes a first inner member 302, a first guidewire 304, asecond inner member 306, a second guidewire 308, a distal tip 310, asheath 312, and a handle 314.

As illustrated in FIG. 3, first and second guidewires 304, 308 extendthrough lumens in first and second inner members 302, 306. Inner members302, 306 and guidewires 304, 308 extend distally from handle 314 andwithin sheath 312. Handle 314 has various mechanisms and ports to allowmanipulation, e.g. retraction or advancement, of guidewires 304, 308,sheath 312 and/or inner members 302, 306 relative to one another.

Distal tip 310 is coupled to first inner member 302, e.g., the distalend thereof, and has a guidewire port 316 through which guidewire 304extends. Second inner member 306 is located between first inner member302 and sheath 312 in this embodiment.

Iliac branch device 100 is loaded within delivery system 300. Moreparticularly, external iliac body 102 and common iliac branch 106 areloaded over first inner member 302. In other words, first inner member302 enters distal opening 108 of external iliac body 102, extendsthrough both external iliac body 102 and common iliac branch 106 andexits proximal opening 122 of common iliac branch 106.

Further, external iliac body 102 and internal iliac branch 104 areloaded over second inner member 306. In other words, second inner member306 enters distal opening 108 of external iliac body 102, extendsthrough both external iliac body 102 and internal iliac branch 104 andexits distal opening 118 of internal iliac branch 104. Second guidewire308 is sometimes called a prewired guidewire 308 in accordance with thisembodiment.

Although delivery system 300 is illustrated and discussed as includingboth inner members 302, 306 and guidewires 304, 308, in anotherembodiment, delivery system includes either inner member 302/guidewire304 or inner member 306/guidewire 308, but not both.

Further, although a particular arrangement of loading of iliac branchdevice 100 within delivery system 300 is illustrated and discussed,other arrangements and delivery systems are used in other embodiments.Generally, iliac branch device 100 is loaded such that external iliacbody 102 is proximal (relative to handle 314) to both internal iliacbranch 104 and common iliac branch 106. Iliac branch device 100 issometime said to be loaded backwards within the delivery system.

Two guidewires are potentially used. The primary guidewire runs throughcommon iliac branch 106. The second guidewire runs through internaliliac branch 104. In other embodiments, a single guidewire is used.Other arrangements are possible.

FIG. 3 illustrates delivery system 300 in a deployed (or pre-loading)state where sheath 312 is withdrawn to expose iliac branch device 100for purposes of illustrating the various features of delivery system300. When in a delivery state, sheath 312 abuts distal tip 310 and iliacbranch device 100 is constrained between sheath 312 and inner members302, 306.

To deploy iliac branch device 100, delivery system 300 is advanced overfirst guidewire 304 to the desired deployment location. For example,delivery system 300 is introduced through an ipsilateral external iliacartery access point and advanced to the desired deployment location.Once at the deployment location, sheath 312 is retracted thus releasingiliac branch device 100. Once released, iliac branch device 100, e.g.,stents 130, self-expands (or is balloon expanded) to be secured in thedeployment location.

In one embodiment, upon retraction of sheath 312 and deployment of iliacbranch device 100, iliac branch device 100 assumes a configurationsimilar to that illustrated in FIG. 1. In accordance with thisembodiment, internal iliac branch 104 is deployed as a straight member.

In another embodiment, second inner member 306 is a resilient curvedmember. Second inner member 306 is constrained in a straight state bysheath 312 when in a delivery state. Upon being deployed and releasedfrom sheath 312, second inner member 306 resumes the curved state ofsecond inner member 306. Curvature of second inner member 306 causescurvature of internal iliac branch 104 as illustrated by the dashedlines in FIG. 3.

In another embodiment, iliac branch device 100A of FIG. 2 is loadedwithin delivery system 300 instead of iliac branch device 100 of FIG. 1.In accordance with this embodiment, referring to FIGS. 2-3 together,internal iliac branch 104A is constrained in a straight state by sheath312 when in a delivery state. Upon being deployed and released fromsheath 312, internal iliac branch 104A resumes the curved state ofinternal iliac branch 104A as illustrated by the dashed lines in FIG. 3.

FIG. 4 is a partial cross-sectional view of a vessel assembly 400including iliac branch device 100 of FIG. 1 in accordance with oneembodiment. FIG. 5 is an enlarged view of the region V of vesselassembly 400 of FIG. 4 in accordance with one embodiment. Referring toFIGS. 4 and 5 together, vessel assembly 400 illustrates a series ofvessels within the human body, including the aorta 402, the common iliacarteries 404, 406, internal iliac arteries 408, 410, and external iliacarteries 412, 414.

More particularly, the aorta 402 descends to an aortic bifurcation 416from which extends common iliac arteries 404, 406. Common iliac artery404 descends to a common iliac artery bifurcation 418 from which extendsinternal iliac artery 408 and external iliac artery 412 at acontralateral side. Similarly, common iliac artery 406 descends to acommon iliac artery bifurcation 420 from which extends internal iliacartery 410 and external iliac artery 414 at an ipsilateral side. Inaccordance with this example, common iliac artery 406 includes an iliacartery aneurysm 422, i.e., a diseased section of tissue.

Referring now to FIGS. 3 and 5 together, iliac branch device 100 isdeployed within common iliac artery 406 and external iliac artery 414.For example, as discussed above, delivery system 300 introduced throughan ipsilateral external iliac artery access point and advanced to thedesired deployment location within common iliac artery 406 and externaliliac artery 414. Sheath 312 is retracted such that iliac branch device100 is deployed with common iliac branch 106 within common iliac artery406 and external iliac body 102 is deployed within external iliac artery414. Distal opening 118 is adjacent to common iliac artery bifurcation420 and generally adjacent or distal of the ostium of internal iliacartery 410. External iliac body 102 provides the distal seal withinexternal iliac artery 414.

In accordance with this embodiment, second guidewire 308 is locatedwithin internal iliac artery 410. For example, second guidewire 308 isprewired as discussed above in reference to FIG. 3 and delivery system300. However, in another embodiment, delivery system 300 does notinclude prewired guidewire 308, and guidewire 308 is advanced andmanipulated to cannulate internal iliac artery 410.

FIG. 6 is a partial cross-sectional view of vessel assembly 400 of FIG.5 at a later stage during deployment of a bridging graft 602 inaccordance with one embodiment. Referring now to FIGS. 5 and 6 together,bridging graft 602 is deployed within internal iliac branch 104 andinternal iliac artery 410.

To deploy bridging graft 602, a delivery system including bridging graft602 is inserted at the same access point as the access point used foriliac branch device 100, e.g., the ipsilateral external iliac arteryaccess point. The delivery system is advanced over guidewire 308 andinto internal iliac artery 410. Bridging graft 602 is then deployed fromthe delivery system, e.g., by withdrawing a sheath thereof. Upondeployment, bridging graft 602 self-expands (or is balloon expanded) tobe located within internal iliac branch 104 and internal iliac artery410. Guidewire 308 is removed.

Bridging graft 602 bridges blood flow from internal iliac branch 104 tointernal iliac artery 410. In one embodiment, bridging graft 602includes graft material 604 and one or more stents 606. Graft material604 and stents 606 are the same or similar to graft material 128 andstents 130 as discussed above.

Referring now to FIGS. 1, 4, and 6 together, once deployed, blood flowenters into proximal opening 122 of common iliac branch 106. Blood flowsthrough lumen 136 of common iliac branch 106 to transition region 126.At transition region 126, a portion of the blood flows through lumen 132of external iliac body 102 and out distal opening 108. Another portionof the blood flows through lumen 134 of internal iliac branch 104,through bridging graft 602, and perfuses internal iliac artery 410.Blood flow through internal iliac branch 104 is retrograde (backwards)blood flow. However, there is a sufficient amount of perfusion ofinternal iliac artery 410 through the retrograde blood flow to avoidserious medical complication from obstruction of internal iliac artery410.

Iliac branch device 100 and bridging graft 602 are deployed from thesame ipsilateral external iliac artery access point. Of note, iliacbranch device 100 and bridging graft 602 are deployed without going upand over aortic bifurcation 416 and without using some form ofsupra-aortic antegrade access such as through brachial or axillaryartery access. This simplifies the procedure and reduces procedure timethus maximizing the success rate of the procedure and allows theprocedure to be performed on a broad patient population.

FIG. 7 is an enlarged view of the region V of vessel assembly 400 ofFIG. 4 after deployment of iliac branch device 100A of FIG. 2 inaccordance with one embodiment. The deployment of iliac branch device100A of FIG. 7 is similar to the deployment of iliac branch device 100of FIG. 5 and only the significant differences are discussed below.

In accordance with this embodiment, distal opening 118 of internal iliacbranch 104A is located directly adjacent and proximal to the ostium ofinternal iliac artery 410. Due to the curvature of internal iliac branch104A, distal opening 118 points towards the ostium of internal iliacartery 410. This simplifies cannulation of internal iliac artery 410with guidewire 308 as the curvature of internal iliac branch 104Afacilitates guiding of guidewire 308.

FIG. 8 is a partial cross-sectional view of vessel assembly 400 of FIG.7 at a later stage during deployment of bridging graft 602 in accordancewith one embodiment. Referring now to FIGS. 7 and 8 together, bridginggraft 602 is deployed within internal iliac branch 104A and internaliliac artery 410 in a manner similar to that discussed above regardingdeployment of bridging graft 602 into internal iliac branch 104 andinternal iliac artery 410 of FIG. 6.

FIG. 9 is a partial cross-sectional view of vessel assembly 400 of FIG.6 at a later stage after deployment of an aortic bifurcated stent graft900 in accordance with one embodiment. Referring now to FIGS. 4, 6, and9 together, in accordance with this embodiment, aorta 402 includes anaortic aneurysm 424. In accordance with this embodiment, aorticbifurcated stent graft 900 excludes aortic aneurysm 424. However, inanother embodiment, aorta 402 is healthy, i.e., does not include ananeurysm.

More particularly, aortic bifurcated stent graft 900 includes a mainbody 902, a first leg 904, and a second leg 906. Examples of aorticbifurcated stent graft 900 includes the Endurant® II AAA stent graftsystem manufactured by Medtronic or other AAA EVAR devices.

In one embodiment, aortic bifurcated stent graft 900 is deployed distalof renal arteries 426, 428 although the deployment location various inother embodiments depending upon the particular application of aorticbifurcated stent graft 900. A first bridging graft 908 is deployedwithin and bridges first leg 904 and common iliac artery 404. A secondbridging graft 910 is deployed within and bridges second leg 906 andcommon iliac branch 106.

FIG. 10A is an enlarged view of the region X of vessel assembly 400 ofFIG. 9 in accordance with one embodiment. FIG. 10A illustrates a firstcomponent A within a second component B.

Referring now to FIGS. 9 and 10A together, illustratively, aorticbifurcated stent graft 900 and iliac branch device 100 are initiallydeployed. After deployment of aortic bifurcated stent graft 900 andiliac branch device 100, bridging graft 910 is deployed within secondleg 906 and common iliac branch 106. In accordance with this embodiment,first component A is representative of bridging graft 910 and secondcomponent B is representative of common iliac branch 106. As illustratedin FIG. 10A, bridging graft 910 (component A) is deployed within andoverlaps common iliac branch 106 (component B) thus forming a sealbetween bridging graft 910 and common iliac branch 106.

FIG. 10B is an enlarged view of the region X of vessel assembly 400 ofFIG. 9 in accordance with another embodiment. FIG. 10B illustratessecond component B within first component A.

Referring now to FIGS. 9 and 10B together, in accordance with thisembodiment, aortic bifurcated stent graft 900 and bridging graft 910 areinitially deployed. Illustratively, aortic bifurcated stent graft 900and bridging graft 910 provide sufficient exclusion of aortic aneurysm424.

However, after a period of time, aortic bifurcated stent graft 900 andbridging graft 910 do not provide sufficient exclusion. Illustratively,aortic aneurysm 424 grows and/or iliac aneurysm 422 is formed or grows.Accordingly, at a later point in time in a follow on procedure, iliacbranch device 100 is deployed to provide sufficient exclusion ofaneurysms 422 and/or 424.

More particularly, common iliac branch 106 is deployed within bridginggraft 910. In accordance with this embodiment, first component A isrepresentative of bridging graft 910 and second component B isrepresentative of common iliac branch 106. As illustrated in FIG. 10B,common iliac branch 106 (component B) is deployed within and overlapsbridging graft 910 (component A) thus forming a seal between commoniliac branch 106 and bridging stent graft 910.

In yet another embodiment, aortic bifurcated stent graft 900 andbridging stent graft 910 are initially deployed and iliac branch device100 is then deployed in a single procedure.

FIG. 11 is a partial cross-sectional view of vessel assembly 400 of FIG.6 at a later stage after deployment of aortic bifurcated stent graft 900in accordance with another embodiment. Vessel assembly 400 asillustrated in FIG. 11 is similar to vessel assembly 400 as illustratedin FIG. 9 except bridging graft 910 of FIG. 9 is not used in accordancewith the embodiment of FIG. 11.

Referring now to FIGS. 4, 6, and 11 together, in accordance with thisembodiment, common iliac branch 106 is joined directly with second leg906 of aortic bifurcated stent graft 900. Illustratively, second leg 906and/or common iliac branch 106 are extended to overlap one another.

FIG. 10B is an enlarged view of the region X of vessel assembly 400 ofFIG. 11 in accordance with this embodiment. Referring now to FIGS. 10Band 11 together, in accordance with this embodiment, aortic bifurcatedstent graft 900 is initially deployed. Illustratively, aortic bifurcatedstent graft 900 provides sufficient exclusion of aortic aneurysm 424.

However, after a period of time, aortic bifurcated stent graft 900 doesnot provide sufficient exclusion. Illustratively, aortic aneurysm 424grows and/or iliac aneurysm 422 is formed or grows. Accordingly, iliacbranch device 100 is deployed to provide sufficient exclusion ofaneurysms 422 and/or 424.

More particularly, common iliac branch 106 is deployed within second leg906. In accordance with this embodiment, first component A isrepresentative of second leg 906 and second component B isrepresentative of common iliac branch 106. As illustrated in FIG. 10B,common iliac branch 106 (component B) is deployed within and overlapssecond leg 906 (component A) thus forming a seal between common iliacbranch 106 and second leg 906.

In yet another embodiment, aortic bifurcated stent graft 900 isinitially deployed and iliac branch device 100 is then deployed in asingle procedure.

FIG. 12 is an enlarged view of the region V of vessel assembly 400 ofFIG. 4 in accordance with one embodiment. Referring to FIGS. 4 and 12together, in accordance with this embodiment, vessel assembly 400includes only an isolated iliac aneurysm 422. In accordance with thisembodiment, iliac branch device 100 alone provides sufficient exclusionof iliac aneurysm 422. Illustratively, common iliac branch 106 forms aproximal seal with common iliac artery 406. External iliac body 102forms a distal seal with external iliac artery 414. Internal iliacbranch 104 and bridging graft 602 form the distal seal with internaliliac artery 410. In this manner, isolated iliac aneurysm 422 isexcluded by iliac branch device 100 alone.

In one embodiment, after a period of time, iliac branch device 100 doesnot provide sufficient exclusion. Illustratively, aortic aneurysm 424 isformed and/or iliac aneurysm 422 grows. Accordingly, aortic bifurcatedstent graft 900 is deployed to provide sufficient exclusion of aneurysms422 and/or 424.

More particularly, referring to FIGS. 10A, 11-12, second leg 906 ofaortic bifurcated stent graft 900 is deployed with common iliac branch106. In accordance with this embodiment, first component A isrepresentative of second leg 906 and second component B isrepresentative of common iliac branch 106. As illustrated in FIG. 10A,second leg 906 is deployed within and overlaps common iliac branch 106thus forming a seal between common iliac branch 106 and second leg 906.

In yet another embodiment, iliac branch device 100 is initially deployedand aortic bifurcated stent graft 900 is then deployed in a singleprocedure.

Although FIGS. 9, 10A, 10B, 11 and 12 are discussed above as includingiliac branch device 100 of FIG. 1, in other embodiments, iliac branchdevice 100A as illustrated in FIG. 2 is used in place of iliac branchdevice 100. Accordingly, the discussion regarding iliac branch device100 in FIGS. 9, 10A, 10B, 11-12 is equally applicable to iliac branchdevice 100A.

It should be understood that various aspects disclosed herein may becombined in different combinations than the combinations specificallypresented in the description and accompanying drawings. It should alsobe understood that, depending on the example, certain acts or events ofany of the processes or methods described herein may be performed in adifferent sequence, may be added, merged, or left out altogether (e.g.,all described acts or events may not be necessary to carry out thetechniques). In addition, while certain aspects of this disclosure aredescribed as being performed by a single module or unit for purposes ofclarity, it should be understood that the techniques of this disclosuremay be performed by a combination of units or modules associated with,for example, a medical device.

What is claimed is:
 1. An assembly comprising: a delivery systemcomprising a handle; and an iliac branch device loaded within thedelivery system, the iliac branch device comprising: an external iliacbody comprising a distal opening; a common iliac branch comprising aproximal opening, a diameter of the proximal opening being greater thana diameter of the distal opening; and an internal iliac branchconfigured to perfuse an internal iliac artery, wherein the entireexternal iliac body is proximal to both the common iliac branch and theinternal iliac branch relative to the handle when the iliac branchdevice is loaded in a delivery state within the delivery system, whereinthe internal iliac branch and the common iliac branch are side by sidewhen the iliac branch device is loaded in the delivery state.
 2. Theassembly of claim 1 wherein the external iliac body is distal to thecommon iliac branch.
 3. The assembly of claim 1 wherein the externaliliac body is bifurcated into the common iliac branch and the internaliliac branch at a transition region.
 4. The assembly of claim 3 whereina proximal end of the external iliac body is coupled to a proximal endof the internal iliac branch and a distal end of the common iliacbranch.
 5. The assembly of claim 4 wherein the distal opening of theexternal iliac body is at a distal end of the external iliac body andthe proximal opening of the common iliac branch is at a proximal end ofthe common iliac branch.
 6. The assembly of claim 5 wherein the internaliliac branch comprises a distal opening at a distal end of the internaliliac branch.
 7. The assembly of claim 6, wherein the external iliacbody comprises a lumen extending between the distal opening of theexternal iliac body and transition region, wherein the internal iliacbranch comprises a lumen extending between the distal opening of theinternal iliac branch and the transition region, and wherein the commoniliac branch comprises a lumen extending between the proximal opening ofthe common iliac branch and the transition region.
 8. The assembly ofclaim 1 wherein a curving member is configured to cause the internaliliac branch to curve away from the common iliac branch.
 9. The assemblyof claim 8 wherein the curving member comprises a wire secured to theinternal iliac branch.
 10. The assembly of claim 9 wherein the wire islocated on an inner curve of the internal iliac branch.
 11. The assemblyof claim 9 wherein the curving member comprises multiple wirescomprising the wire.
 12. The assembly of claim 8 wherein the curvingmember comprises stitching.
 13. The assembly of claim 8 wherein thecurving member is configured to cause the internal iliac branch to havea hook shape.
 14. An assembly comprising: a delivery system comprising:a handle; an inner member; and a second inner member; and an iliacbranch device loaded within the delivery system, the iliac branch devicecomprising: an external iliac body configured to be located within anexternal iliac artery; a common iliac branch configured to be locatedwith a common iliac artery; and an internal iliac branch configured toperfuse an internal iliac artery, wherein the entire external iliac bodyis proximal to both the common iliac branch and the internal iliacbranch relative to the handle when the iliac branch device is loaded ina delivery state within the delivery system, wherein the inner member islocated within the external iliac body and the common iliac branch andexits a proximal opening of the common iliac branch; and wherein secondinner member is located within the external iliac body and the internaliliac branch and exits a distal opening of the internal iliac branch.15. The assembly of claim 14 further comprising a sheath constrainingthe iliac branch device.
 16. The assembly of claim 14 further comprisinga first guidewire within a lumen of the inner member.
 17. The assemblyof claim 16 further comprising: a second guidewire within a lumen of thesecond inner member.
 18. The assembly of claim 14, wherein the externaliliac body comprises a distal opening, wherein a diameter of theproximal opening of the common iliac branch is greater than a diameterof the distal opening of the external iliac body.
 19. A methodcomprising: loading an iliac branch device within a delivery systemcomprising a handle, the iliac branch device comprising: an externaliliac body; a common iliac branch; and an internal iliac branch, whereinthe entire external iliac body is proximal to both the common iliacbranch and the internal iliac branch relative to the handle when theiliac branch device is loaded in a delivery state within the deliverysystem, and wherein the internal iliac branch and the common iliacbranch are side by side when the iliac branch device is loaded in thedelivery state.
 20. The method of claim 19 further comprising:introducing the delivery system through an ipsilateral external iliacartery access point; advancing the delivery system to a deploymentlocation; and deploying the iliac branch device at the deploymentlocation, wherein the external iliac body is located within an externaliliac artery and the common iliac branch is located within a commoniliac artery.
 21. The method of claim 20 further comprising deploying abridging graft within the internal iliac branch and an internal iliacartery.
 22. The method of claim 20 further comprising deploying anaortic bifurcated stent graft in an aorta, wherein the common iliacbranch is directly coupled to a leg of the aortic bifurcated stentgraft.
 23. The method of claim 20 further comprising deploying an aorticbifurcated stent graft in an aorta, wherein the common iliac branch iscoupled to a leg of the aortic bifurcated stent graft by a bridginggraft.